Kentucky is one of a handful of states recently approved to provide health insurance coverage to soon-to-be released incarcerated individuals.

The new rules allow Kentucky to provide Medicaid and CHIP coverage up to 90 days before a person's reentry into society.

John Bowman, senior campaign organizer for the nonprofit Dream.org, said the move will help people reentering society avoid gaps in coverage and reduce barriers to treatment for chronic diseases and substance use disorders.

"Getting these resources in place before they leave incarceration is it's going to be a game changer," Bowman asserted. "Hopefully, we can get to the point where we get it in our county jails as well, instead of just our prisons. Right now, our county jails are excluded."

The new rules also apply to youths in juvenile detention centers who are eligible for the Children's Health Insurance Program, or CHIP. According to federal data, an estimated 80% of returning community members have chronic medical, psychiatric or substance use disorders.

Research has shown overcrowding, poor conditions and lack of access to care can increase infectious diseases in jails, including COVID. During the pandemic, incarcerated people were three times more likely to die from coronavirus than the general population. Bowman noted people with a chronic condition often become sicker in prison or develop medical conditions they did not previously have.

"There is a real lack of health care for incarcerated individuals," Bowman observed. "We just stick them in a cage and then forget about them. The lack of health care in there is, honestly, very demeaning and very sad."

According to the Prison Policy Initiative, all federal prisons and at least 40 states charge incarcerated people an average copay of around $2 when seeking medical care.

Bowman added he hopes Kentucky can expand on access to evidence-based substance use treatment and recovery services, including peer support specialists through Medicaid for people working to piece their lives back together after incarceration.


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With demand for assistance dogs on the rise, people in two West Virginia prisons are getting involved in their training.

At Saint Marys Correctional Center and Lakin Correctional Center in West Columbia, incarcerated men and women can participate in the paws4prisons® program, learning how to train assistance dogs. They begin by teaching basic and advanced commands to rescue dogs, then graduate to training assistance dogs which learn around 100 commands.

Amanda Rubenstein, associate superintendent of programs for the West Virginia Division of Corrections and Rehabilitation, said the dogs have an effect on everyone around.

"Even the facilities in general, the other inmates that aren't in the program have so much respect for it," Rubenstein observed. "We have inmates that haven't petted dogs in years that come here, you know, 'Oh my gosh, there's dogs in prison.' They may not want to be a part of the program, but they love interacting. They love the mission."

She noted the dogs go everywhere in the facility with their handlers and sleep in kennels next to their beds.

Recent research shows veterans with Post-Traumatic Stress Disorder have seen their symptoms reduced, reporting lower rates of depression and anxiety after three months with a service dog. Incarcerated people often suffer from PTSD and Complex PTSD. Research also suggests prison-based dog training programs help people involved feel hope and develop a number of life skills.

"It teaches them responsibility, how to be better mothers, fathers, better family members, better citizens overall," Rubenstein outlined. "I think that responsibility aspect, and then, just the feeling of normalcy again for them."

paws4prisons® is an offshoot of paws4people®. They train Labrador Retrievers, Golden Retrievers and a mix of the two breeds known as Goldadors. Dogs begin training at around 5 months old. Trainers have weekly meetings by phone and video conference with paws4people® staff. Incarcerated people must apply to join the program, and given the amount of training involved, Rubenstein stressed they seek candidates who have enough time.

"We also look at inmates that are going to be incarcerated a little longer, because the academics last anywhere from six to nine months," Rubenstein explained. "We want to make sure they have time to complete that and then use those skills that they learned in academics. I prefer someone that has at least 18 months before they see the parole board or discharge."

She added assistance dog training takes between a year and 18 months.


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New data shows incarceration has ballooned in Kentucky's rural counties, and less populated regions are building more jails.

The findings come from an analysis of jail-offenses data by the nonprofit Prison Policy Initiative. Wanda Bertram, a communications strategist for the organization, said small towns and counties pour a huge amount of public resources into arrests for minor offenses. She added that those same counties are doubling down on policing and prosecution policies.

"Incarceration is a costly business," she said. "It is extremely destabilizing for people who go to jail, and it may or may not actually do anything to improve public safety."

The average county in Kentucky had about 12,000 people incarcerated in 2019. That number has decreased to around 10,000 in 2024, according to the Kentucky Association of Counties.

Across the country, Bertram said, most counties see jails as a place to hold people charged with low-level offenses or misdemeanors.

"Two thirds of people are being held on charges that did not involve physical violence against another person," she said.

According to federal data from 2023, 20% of people in jails were held for misdemeanors. According to the Jail Data Initiative, the actual number of people in jails that year for non-violent offenses is closer to 35%.


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More than 60 Pennsylvania counties do not have enough public defenders for their caseloads, forcing some, including in Erie County, to each handle more than 400 cases a year.

A report by Quattrone Center at the University of Pennsylvania said the state needs more than 1,200 full-time public defenders but has about 850.

Sara Jacobson, executive director of the Public Defender Association of Pennsylvania, said the state was one of only two providing no funding for public defense but $7.5 million was allocated in the last two state budgets. Jacobson acknowledged it has helped, although spread across 67 counties, it is not enough to make real change in places like Erie County.

"Erie got in 2023-2024 a little over $102,000. The second appropriation: $106,723," Jacobson pointed out. "The problem is that when you add the cost of an attorney's salary and benefits, the money that's there is not enough when it gets divided up."

The report found Erie County would need 28 full-time attorneys to handle the large caseload but currently has nine full-time and eight part-time attorneys. At a recent news conference, Clinton County Commissioner Jeff Snyder said the state's allocation of funding for indigent defense would have to double, to $15 million a year to handle the growing need.

Jacobson noted heavy caseloads cause delays, both for public defenders and clients. She added prior to the pandemic, Erie County had top public defender pay but now, some attorneys are leaving for better-paying work in the Erie conflict office.

"Conflict Counsel in Erie County gets paid more and has a far lower caseload," Jacobson explained. "Every time someone leaves, their 400 or however many cases have to be distributed among the other lawyers. So those caseloads go up and the service to those clients goes down because of it."

Jacobson cited a Vanderbilt Law School study, which found each exoneration for a wrongful conviction costs a state $6.1 million. With at least 140 exonerations, it adds up to $856 million in costs for Pennsylvania.